Provider Demographics
NPI:1619490059
Name:ALLEN, JAMIE MAE (BA CADC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MAE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BA CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E EUCLID AVE STE 157
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4583
Mailing Address - Country:US
Mailing Address - Phone:515-381-3001
Mailing Address - Fax:
Practice Address - Street 1:100 E EUCLID AVE STE 157
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4583
Practice Address - Country:US
Practice Address - Phone:515-381-3001
Practice Address - Fax:515-381-3001
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090817101YM0800X
IA171400000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach